Heartfile moves Pakistan toward universal health coverage

Meet Majid. This 15 year old boy is the primary earner for his family in Pakistan. Majid was hit by a tractor, leaving him out of a job, with no money for an operation, and a starving family. More than 120 million people in Pakistan pay out of pocket for needed health care services. As a result, many are at risk of catastrophic expenditures that lead to a downward spiral of poverty or the possibility of becoming indebted for life.

One organization is trying to change this picture, by actively seeking patients who are at risk. Heartfile Health Financing, profiled on the Center for Health Market Innovations, is an example of the type of private sector innovation that can be used to mobilize progress towards universal health coverage (UHC).

Heartfile is using an IT-supported, automated demand side health financing instrument (website) that can be accessed by local health care workers to seek urgent support for those running the risk of spending, catastrophically. The program links to the government’s National Database Registration Authority to ascertain a patient’s poverty status and has the ability to channel the necessary funding for eligible patients – all within 72 hours. Through the technology, donors can earmark and track their donations, and receive real-time updates on the individual patients they are supporting.

At a panel discussion hosted by the International Partnership for Innovation (IPIHD) and Partners for a New Beginning Secretariat, discussants explored Heartfile as a potential model for achieving UHC efforts through innovations in financing. What is the private sector’s role in achieving UHC? What are the challenges and best practices we can draw from the Heartfile experience? And how can we scale up and replicate successful models in the push towards universal coverage?

Aspen Institute-IPIHD panel with Heartfile innovators

Representing Heartfile, Dr. Anis Kazi provided an overview of the organization’s approach to social protection health financing through a unique public-private partnership model, noting that Dr. Sania and her team have been great advocates of Heartfile existing as an independent NGO as well as a part of the broader health system – “The system was a line of the greater aim and objective in terms of reforming Pakistan’s health system – it’s not existing in isolation but integrated with the public sector.”

Dr. Jono Quick, President and CEO for Management Sciences for Health (MSH), noted that Heartfile has succeeded in integrating product innovation with health systems innovation – “this is in identifying new ways of organizing people, processes, and resources to deliver existing products, practices, and technologies at scale with good value and impact.” Dr. Quick shared that MSH is partnering with Heartfile to scale the model in Africa, with the goal of using the health financing model to drive progress towards UHC.

Other comments focused on lessons learned from the Heartfile model, and what has made the program particularly successful and innovative in its link to UHC. Richard Bartlett, Associate Director at IPIHD, pointed to the explicit use of technology as an enabler to the solution, but not as the solution itself, as a key factor. He pointed to programs like Sproxil, Inc., which allows consumers to check drug authenticity by mobile phone technology, as another example of programs that first identify the health system need, and then use technology as the enabler to address the need.

Richard also used the example of Naya Jeevan, a micro health insurance model based in Pakistan, as another successful model that puts the patient in the middle of the solution, rather than expecting the patient to be around the solution. Similar to Heartfile, this program has examined existing supply chains to understand where the poor interact with providers, to design a model of care that gets at patients in their localities and through existing delivery mechanisms.

The session closed with comments by video from Dr. Tim Evans, the new lead for Health and Human Development at the World Bank, who focused on the relation between the public and private sectors in the move towards UHC. Dr. Evans noted that many low-income countries face enormous fiscal pressures and massive inefficiencies in operational processes, which hamper progress toward national reforms like UHC: “The rate at which that situation will change is slow, so it’s unrealistic to think that somehow the state will finance everything immediately.” At the same time, the healthcare economy is growing at a rapid pace – which points to the need to be more aggressive in promoting innovative solutions – Heartfile is one such example.

So, what are the points of entry for private sector innovation for UHC? First, programs need to think beyond the traditional Beveridge and Bismarck financing models – “it isn’t the state that is going to be the engine for UHC in the short- to medium-term” Dr. Evans shared. While the state can and should have a leading role in health financing reforms, it can’t do it alone. Activities can range from mobilization to pooling to purchasing, which will require coordination across a wide variety of players and innovative approaches to ensure that they protect the poor from financial catastrophe and ensure access to good quality care in a timely way.

As countries increasingly take up the UHC banner, it’s become clear that they need to address both the financing and delivery side – both of which will need to involve private actors in order to be successful. As Dr. Quick stated, “There can’t be a universal solution without the private sector. Not only because of its pervasiveness in terms of health infrastructure, but also in terms of innovation and efficiency. Heartfile gives us one sustainable solution through the private sector.”

This post was also published on UHC Forward, a resource on Universal Health Coverage in low- and middle-income countries.